OBJECTIVE To evaluate early indicators of pulmonary hypertension (PH) in children and adolescents with sickle cell anemia (SCA) using non-invasive diagnostic methods. Material and Methods A total of 29 pediatric patients diagnosed with SCA (aged ≥10 years) and 23 age and sex matched healthy controls were enrolled. All participants underwent echocardiographic evaluation, pulmonary function tests, electrocardiography, and a six-minute walk test. Laboratory parameters including B-type natriuretic peptide (BNP), lactate dehydrogenase, bilirubin, and uric acid were analyzed. Cardiac systolic and diastolic functions were assessed using tissue Doppler imaging and myocardial performance index (MPI). RESULTS SCA patients showed significantly higher tricuspid regurgitant velocity, systolic and mean pulmonary artery pressures, and MPI values for both ventricles compared to controls. Pulmonary acceleration time was lower, and BNP levels were significantly elevated, positively correlating with left ventricular end-diastolic diameter and right ventricular MPI. Pulmonary function tests suggested a restrictive pattern, and the six-minute walk distance was significantly reduced. CONCLUSION Although PH was not definitively diagnosed, early alterations in cardiac function and elevated BNP levels suggest a subclinical predisposition to PH in pediatric SCA patients. Non-invasive screening methods may be valuable for early detection.